严重烧伤休克期不同时间段晶体复苏液含量的变化对体内环境的影响

The Content Change of Crystal Resuscitation Fluid in the Different Time of Shock Stage of Severe Burns on the Influence of Internal Environment of the Body.

目的:分析严重烧伤休克期不同时间段晶体液含量的变化与血清pH值、碱缺失(BD)、阴离子间隙(AG)及钠离子之间的关系,探讨其对体内环境的影响。方法:对1996年1月至2002年10月间住院的121例重度以上烧伤病人休克期不同时间段的补液情况和306次同步血气分析与电解质的结果进行回顾性分析。结果:(1)休克复苏液中晶体液的百分含量在0h～8h最高,以后明显降低,8h以后各组与0h～8h组比较有显著性差异(P<0.01)。(2)血清pH在0h～8h、8h～16h明显降低,与对照组相比较有极显著性差异(P<0.01),在16h～24h、24h～48h无显著性差异,在48h～72h明显升高,与对照组相比较有极显著性差异(P<0.01)。(3) 血清BD在0h～8h、8h～16h及16h～24h明显降低,与对照组相比较有极显著性差异(P<0.01)。在24h～48h、48h～72h无显著性差异。(4) 血清AG在0h～8h、8h～16h及16h～24h明显升高,与对照组相比较有极显著性差异(P<0.01)。在24h～48h、48h～72h无显著性差异。(5) 血清钠离子在0h～8h、8h～16h及16h～24h均无显著性差异。在24h～48h、48h～72h降低有极显著性差异(P<0.01)。结论:烧伤休克期不同时间段晶体液含量的变化与血液酸碱度、血清钠离子的变化密切相关。严重烧伤休克期不同时间段体内酸碱度有变化,早期呈酸性,48h后呈碱性,血清pH值与血清BD的变化呈正相关,与血清AG的变化呈负相关。烧伤休克期不同时间段晶体液含量的变化与血清钠离子的变化呈正相关。

Objective： To investigate the dynamical change relation between crystal resuscitation fluid content and serum pH, base deficit （BD）, anion gap （AG） and sodium ion at different phase of shock stage of severe burns so as to explore its influence on the internal environment of the body. Methods： 121 hospitalized patients with severe burn injury were collected in the period of 1/1996 - 10/2002. A retrospective assessment on the patients＇ fluid infusion records and 306 times synchronous blood gas and electrolyte analysis results was made. Results： 1. In a period of 0h - 8h posthurn, the percentage content of crystal solution of shock resuscitation fluid was highest, then was reduced significantly. There was significant difference （P 〈 0. 01 ） between the group （0h -8h） and other groups （8h later）. 2. Serum pH was reduced significantly in the 0h -8h group and 8h - 16h group, compared with the control group, there was a very significantly difference （P 〈 0. 01）. During the 16h -24h time period and 24h -48h time period, serum pH value was no significant difference between treatment group and control group. In the 48h -72h time period, serum pH value was significant high, compared with the control group, there was a very significant difference. 3. During 0h -8h, 8h - 16h, and 16h -24h time period, the serum BD value was reduced significantly in the treatment group, compared with the control group, there was a very significant difference （P 〈0. 01 ）. But there was no significant difference between the treatment group and the control group during the 24h - 48h and 48h - 72 time period. 4. During 0h - 8h, 8h - 16h, and 16h - 24h time period, the serum AG value was significantly high in the treatment group, compared with control group, there was a very significant difference （ P 〈 0. 01 ）. But there was no significant difference between the treatment group and the control group during 24h - 48h and 48h -72h time period. 5. During 0h-8h, 8h- 16h, and 16h -24h time period, the serum Na ＋ value was no significant difference between the treatment group and the control group. But during 24h -48h and 48h -72h time period, the value had a very siguifieant different （P 〈 0. 01 ）. Conclusion： In the different time periods of severe burn shock patients, there was a closely eorrelation between the change of the content of crystal solution and blood pH value and serum Na ＋ value ; there was a change of the pH value observed. At the early stage, it presented acid, and then alkali after 48h. The changes of serum pH value was a positively correlation with that of serum BD value, and was a negative correlation with that of serum AG value. The change of the content of crystal solution during burn shock stage was a positive correlation with that of serum Na^＋.